Reversible leukoencephalopathy associated with organotin poisoning.

INTRODUCTION

Organotin compounds are widely used in the plastic industry. We demonstrate the role of brain magnetic resonance imaging in a patient with leukoencephalopathy.

CLINICAL COURSE: A 38-year-old man who worked with trimethyltin and dimethyltin in a polyvinyl chloride factory reported a two-week progression of impaired memory, loss of balance, apathy, tinnitus, scaly darkened skin, and psychomotor slowing that rendered him unable to continue his daily activities. Magnetic resonance imaging revealed diffuse bilateral white matter lesions. Tin concentrations in both blood (344 μ/L) and urine (3,050 μg/L) were elevated. Removal from exposure and treatment with succimer were associated with clinical, laboratory, and imaging improvements.

DISCUSSION: The high lipid content of myelin is a likely target for lipid-soluble alkyl tin compounds.

CONCLUSIONS

This patient demonstrates the clinical and magnetic resonance imaging findings of organotin toxicity. The contribution of chelation to the patient's recovery is uncertain and warrants further study.